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    Jefferson Adams
    Celiac.com 06/08/2016 - Sometimes, certain cases can stand out and grab the attention of clinicians or researchers. Such is the case of a 62-year-old woman who was suffering from severe malabsorption, and diagnosed with celiac disease based on the findings of flat, small intestinal mucosa and HLA-DQ2 positivity, although celiac blood tests were negative.
    A team of researchers questioned the diagnosis, because the woman showed no clinical or histological improvement after a long period of strict gluten-free diet.
    The research team included U Volta, MG Mumolo, G Caio, E Boschetti, R Latorre, F Giancola, P Paterini, and R De Giorgio. They variously are affiliated with the Department of Medical and Surgical Sciences at the University of Bologna, and with the Gastroenterology Unit in the Department of Gastroenterology at the University of Pisa in Italy.
    Based on the detection of enterocyte autoantibodies, the team found that the correct diagnosis for the woman was autoimmune enteropathy. After appropriate immunosuppressive treatment, the woman experienced the disappearance of all symptoms, and a complete recovery.
    Based on this case, the team notes that doctors should consider autoimmune enteropathy in the differential diagnosis of malabsorption with severe villous atrophy, including those cases with negative celiac-related serology.
    Source:
    Gastroenterol Hepatol Bed Bench. 2016 Spring;9(2):140-5.

    Jefferson Adams
    Celiac.com 06/29/2016 - As part of a call for public comment that expired on May 30, 2016 at 8:00 PM EST, the U.S. Preventive Services Task Force issued a Draft Recommendation Statement regarding celiac disease screening.
    The draft was distributed solely for the purpose of receiving public input. It has not been disseminated otherwise by the USPSTF. The final Recommendation Statement will be developed after careful consideration of the feedback received and will include both the Research Plan and Evidence Review as a basis.
    The statement is intended for adults, adolescents, and children who do not have signs or symptoms of celiac disease. The statement is basically a call for more evidence. It expresses the USPSTF conclusion that the current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic persons.
    The USPSTF website regarding this announcement includes information on the Rationale, Clinical Considerations, Other Considerations, Discussion, Recommendations of Others, and References.
    Current testing recommendations include:
    The American College of Gastroenterology recommends that asymptomatic persons with a first-degree relative who has a confirmed diagnosis of celiac disease be considered for testing. Patients with type 1 diabetes mellitus should be tested for celiac disease if there are any digestive symptoms, signs, or laboratory evidence suggestive of celiac disease.
    The U.K. National Institute for Health and Care Excellence recommends offering serologic testing for celiac disease to persons with a first-degree relative with celiac disease or persons with type 1 diabetes mellitus or autoimmune thyroid disease upon diagnosis. Serologic testing for celiac disease should be considered for persons with any of the following: metabolic bone disorder (reduced bone mineral density or osteomalacia), unexplained neurologic symptoms (particularly peripheral neuropathy or ataxia), unexplained subfertility or recurrent miscarriage, persistently elevated liver enzymes with unknown cause, dental enamel defects, Down syndrome, or Turner syndrome.
    The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends testing for celiac disease in asymptomatic children who have conditions associated with celiac disease (type 1 diabetes mellitus, autoimmune thyroiditis, Down syndrome, Turner syndrome, Williams syndrome, selective IgA deficiency, and first-degree relatives with celiac disease). It recommends testing asymptomatic children who are at risk beginning around age 3 years, provided they have had an adequate gluten-containing diet for at least 1 year before testing. It recommends that asymptomatic persons with negative serology who are at risk be considered for repeat testing.19
    Read more at: uspreventiveservicestaskforce.org 

    Jefferson Adams
    Celiac.com 09/22/2016 - There really hasn't been much study done on diagnostic delays and factors associated with celiac disease, as well as on its potential impact on the course of disease.
    To get a better idea of the issue, a research team recently conducted a large systematic patient survey study among unselected celiac disease patients in Switzerland.
    The research team included SR Vavricka SR, N Vadasz, M Stotz, R Lehmann, D Studerus, T Greuter, P Frei, J Zeitz, M Scharl, B Misselwitz, D Pohl, M Fried, R Tutuian, A Fasano, AM Schoepfer, G Rogler, and L Biedermann. They are variously affiliated with the Division of Gastroenterology and Hepatology at Triemli Hospital Zurich in Zurich, Switzerland, IG Zöliakie, Basel, Switzerland, the Division of Gastroenterology and Hepatology at University Hospital Zurich, Zurich, Switzerland, the Division of Gastroenterology and Hepatology, Gastroenterology Bethanien, Zurich, Switzerland, the Division of Gastroenterology and Hepatology, Spital Tiefenau, Bern, Switzerland, the Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, USA,and with the Division of Gastroenterology and Hepatology, University Hospital Lausanne - CHUV, Lausanne, Switzerland.
    They broke their study down into patient-associated delays, and doctor-associated delays. They found an average total diagnostic delay of 87/24 months (IQR 5-96), with a range from 0 up to 780 months, which was fairly equally divided between doctor delay and patient delay. Both mean/median total (93.1/24 vs. 60.2/12, p<0.001) and doctors' (41.8/3 vs. 23.9/2, p<0.001) diagnostic delay were significantly higher when comparing female vs. male patients, and interestingly patients' delay was similar even after an irritable bowel syndrome diagnosis.
    Patients with a diagnostic delay shorter than 2 years showed a substantially lower dependence on steroids and/or immunosuppressants, better substitution for any nutritional deficiency, and were more likely to be symptom-free between 6 and 12 months after diagnosis.
    Regular, substantial delays in diagnosing celiac disease, are linked to worse clinical outcomes, and this data shows that such delays are significantly longer in female patients.
    This increased diagnostic delay in women is the fault of doctors, not patients, in part because the delay statistics cannot be explained by a diagnosis of IBS prior to celiac disease diagnosis.
    Source:
     Dig Liver Dis. 2016 Jun 23. pii: S1590-8658(16)30475-3. doi: 10.1016/j.dld.2016.06.016.

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